Caries frequency in children with controlled diabetes. The frequency of caries was assessed in 33 diabetic children in whom the diabetes required insulin and dietary restriction and had been diagnosed before eruption of the permanent teeth. The frequency of caries and the number of erupted teeth were obtained from the dental records of the school dental service. Age- and sex-matched non-diabetic classmates served as controls. The mean number of DFS at the last dental examination of the diabetic children was 13.4, compared with 20.5 in the controls. The difference was largest in 12- to 14-year-old children, particularly in the premolar region, where the mean number of carious and filled surfaces in the diabetics was 2.6 compared with 5.9 in the controls. In all age groups, proximal carious lesions were less common in the diabetics than in the controls. No notable difference was found between the mean number of erupted teeth in the diabetics and that of the controls, except among the 12- to 14-year-old children. In that age group the diabetics had, on the average, 6.0 erupted premolars compared with 7.3 in the controls and 2.7 erupted permanent second molars compared with 3.5 in the controls. The results indicate that the dietary restriction observed by the diabetics had a favorable effect in promoting a lower caries frequency on all groups of teeth and on most tooth surfaces.


Creep of dental amalgam as a function of heat treatment. The creep of dental amalgam was measured as a function of heat treatment of the amalgam. The treatment significantly reduced the creep rate. The beta 1 (Ag-Hg) phase was detected in the heat-treated amalgam by X-ray diffraction and metallographic methods, and it appeared that the reduction in creep rate was due to the gamma 1 leads to beta 1 transformation.


The effect of secretin and cholecystokinin on the duodenal motility in man.


Duodenal regulation of a fluid test meal in malabsorptive states (such as glutenenteropathy, chronic panreatitis, short bowel syndrome and shunt operated obese patients).


Nervous control of gastroduodenal motility and emptying.


Gastric emptying of a fluid test meal in healthy volunteers and patients with duodenal ulcer before and after selective proximal vagotomy.


The effect of cholecystokinin on the in vitro motility of the guinea-pig stomach.


The significance of distention for the effect of glucagon on the fundic and antral motility in isolated guinea-pig stomach.


Gastric myoelectrical activity in man.

Gastric myoelectrical activity in man.


The significance of motility for the acid base regulation of the duodenal bulb.


Interactions of the duodenal receptors which control gastric emptying.


Monosomy 7 in two adult patients with acute myeloblastic leukaemia. Two patients with acute myeloblastic leujaemia were found to have a population of bone marrow cells with C-group monosomy. Using the Quinacrine Mustard fluorescence technique the lacking chromosome was in both patients identified as a number 7. Both patients entered a complete remission. Monosomy 7 may indicate a separate entity of acute myeloblastic leukaemia associated with a comparatively favourable prognosis.


Chromosome banding studies in acute leukaemia at diagnosis. Cytogenetic study by a chromosome banding technique has been attempted in 93 cases of acute leukaemia at diagnosis. Banding patterns were difficult to visualise in the bone-marrow chromosomes of patients with acute leukaemia because of the fuzzy appearance of the fixed metaphases. The proportion of patients with abnormal chromosomes was higher in acute lymphoblastic (ALL) than in acute myeloid (AML) leukaemia. Abnormalities were present in all cases of other cytological types. Hyperdiploidy was the most commonly found numerical error in both ALL and AML but a larger proportion of patients with ALL had hyperdiploidy in more than 30% of the cells. In ALL it was generally found that the higher the frequency of hyperdiploidy the greater was the number of chromosomes per cell. Hypodiploidy not attributable to random losses was found in only 6 patients. Clones identified by rearranged or marker chromosomes were found in all types of leukaemia. Clones marked by a 7q-chromosome, in which the break point was the same, were identified in 1 adult with ALL and 2 children with AML. The high frequency of randomly disturbed chromosomal breakage found in the bone-marrow chromosomes of a high proportion of the patients may be related to the disease process.


A comparative study of mefenamic acid and oxyphenbutazone in soft tissue lesions.


Megakaryocyte quantifications in relation to thrombokinetics in primary thrombocythaemia and allied diseases. Megakaryocyte morphology was studied quantitatively in primary thrombocythaemia (PT) and in chronic myelogenous leukaemia (CML). The relation of thrombokinetics to megakaryocyte quantifications was evaluated in PT and compared to previously obtained results in polycythaemia vera (PV) and idiopathic thrombocytopenic purpura (ITP). Megakaryocyte area, number and volume per mul bone marrow were significantly higher in PT as compared to controls. The nuclear lobe number was significantly increased and the megakaryocytes were shifted towards more mature forms, suggesting a prolonged megakaryocyte generation time. In CML the megakaryocyte number and volume per mul bone marrow were also significantly above normal, but the megakaryocyte area, number of lobes and degree of megakaryocytic maturation were significantly below normal. Platelet production was in PT 6.2 times normal and proportional to the increase in megakaryocyte volume which was 6.8 times normal. In PV with major splenomegaly the mean platelet production rate was higher (9.5 times normal) although their peripheral platelet count was lower than in PT. This discrepancy is explained by the greatly enlarged splenic platelet pool in the PV patients. In ITP the mean platelet production rate was 2.2 to 3 times normal and was significantly lower than in PT and PV.


Thirty-three year old man with fever, chills, and rash of one week duration.


Molecular vehicle properties of the broad host range plasmid RK2. The pladmid RK2 is stably maintained in a broad range of gram-negative bacteria. The RK2 DNA has a single Eco RI restriction site. The insertion of a DNA fragment into this site does not interfere with either plasmid maintenance or self-transmissibility. Because RK2 has a broad host range, it should be useful for the construction in vitro of hybrid plasmid molecules capable of being established by conjugal transfer or transformation into many genera of gram-negative organisms.


Editorial: Transfer factor therapy: current status.


Leukaemoid reaction and disseminated tuberculosis. A case report. Four cases of leukaemoid reactions to tuberculosis, notwithstanding the presence of Auer's rods in the myeloblasts, have previously been reported. A fifth case of disseminated tuberculosis in which Auer's rods were similarly observed, is described. However, we believe that this association does not mean that Auer's rods occur as part of a leukaemoid response, but rather that it indicates the simultaneous presence of acute leukaemia and tuberculosis.


Fluoride uptake from prophylactic dentifrices. VI. In vivo and in vitro fluoride uptake from a sodium fluoride nonabrasive dentifrice and a monofluorophosphate abrasive dentifrice.


Dummy- and finger-sucking habits in 4-year-olds.


Significance of a prothrombin assay method using Echis carinatus venom for diagnostic information in disseminated intravascular coagulation syndrome.


[The surgical treatment of mandibular fractures]. In certain cases, open reduction of the fragments is absolutely necessary in mandibular fracture treatment. According to an evaluation of the relevant literautre and to the author's studies, plate osteosynthesis ensures functional stability. For the treatment of certain mandibular fractures the author composed a set for plate osteosynthesis. The use of this set in the management of mandibular fractures and in osteoplastic interventions is illustrated by two casuistic contributions.


Canine osteosarcoma karyotypes from an original tumor, its metastasis, and tumor cells in tissue culture. Radiation-induced osteosarcoma, its metastasis, and cells grown in tissue culture were karyotyped. Both hypodiploid and hyperdiploid stem lines were observed. The hypodiploid line contained 45-55 chromosomes with 10-15 abnormal metacentric and submetacentric chromosomes and one subtelocentric marker. The hyperdiploid line contained 90-105 chromosomes with 20-30 abnormal metacentric and submetacentric chromosomes with two subtelocentric markers. Karyotypic analysis can be used to monitor osteosarcomas maintained in tissue culture.


Fetal-tumor membrane associated antigens: genetic and immunological implications.


Optic disc in glaucoma.

Optic disc in glaucoma.


Angle changes and their role in glaucoma.


Nerve fibre defects.

Nerve fibre defects.


Visual field in glaucoma.

Visual field in glaucoma.


Status of tonography and provocative tests.


Therapeutic decisions in glaucoma.

Therapeutic decisions in glaucoma.


Medical control of open angle glaucoma.

Medical control of open angle glaucoma.


Leukapheresis of a five-year-old girl with chronic granulocytic leukemia. A therapeutic leukapheresis of a five-year-old girl with adult-type chronic granulocytic leukemia is described, with techniques for minimizing the effects of hypovolemia. The patient's unduly rapid response to chemotherapy suggested that the procedure had effected a substantial reduction in the leukocyte mass.


Surgery for open angle glaucoma.

Surgery for open angle glaucoma.


Management of angle closure glaucoma.

Management of angle closure glaucoma.


Iatrogenic glaucoma.

Iatrogenic glaucoma.


Surgery for glaucoma in the young.

Surgery for glaucoma in the young.


Glaucoma. Therapeutic prospects.

Glaucoma. Therapeutic prospects.


Patient with low-tension glaucoma.

Patient with low-tension glaucoma.


A case of juvenile glaucoma.

A case of juvenile glaucoma.


An unusual case of glaucoma resembling malignant glaucoma.


Exfoliative syndrome.

Exfoliative syndrome.


Non-glaucomatous arcuate scotomata.

Non-glaucomatous arcuate scotomata.


Glaucoma services in New Zealand.

Glaucoma services in New Zealand.


Nonvascular glaucoma.

Nonvascular glaucoma.


Blindness in childhood in New Zealand.

Blindness in childhood in New Zealand.


Glaucoma and central vein occlusion.

Glaucoma and central vein occlusion.


Retinal branch vein occlusion.

Retinal branch vein occlusion.


Current management of diseases of the macula.


Successes and failures with light coagulation.


Ophthalmic considerations in carotid artery disease.


Treatment of cancer of the lid edge.

Treatment of cancer of the lid edge.


The colour of the fundus.

The colour of the fundus.


Haemangioma in lacrimal sac region, a case report.


Optical lenses and the ophthalmologist.

Optical lenses and the ophthalmologist.


Aneurysms of the thoracic aorta: current approach to treatment.


The hyperkinetic syndrome.

The hyperkinetic syndrome.


Megaloblastic anemia in the management of severe psoriasis.


When all the tests are negative.

When all the tests are negative.


Infectious diarrheas.

Infectious diarrheas.


The shape of the amniotic pressure curve before and after paracervical block during labour. Paracervical block (PCB) given during labour reduces the uterine activity necessary for cervical dilatation. The aim of the present investigation was to find out whether this effect of PCB changes the form of the amniotic pressure curve. A preliminary investigation showed that the ascending limb of the amniotic pressure curve, A, consists of three phases. The first phase shows an increasing slope and is called the acceleration phase of the ascending limb, Aa; the second phase is rectilinear, Ar. The third phase has a decreasing slope, and is named the deceleration phase, Ad. The descending limb of the amniotic pressure curve, D, was found to have corresponding phases. The initial part has a downward increasing slope and is called the acceleration phase of the descending limb, Da. Then follows a rectilinear phase, Dr and finally a phase with a decreasing slope, the deceleration phase, Dd. The duration of each phase, except Dd, was measured during an observation and a treatment period in 27 patients receiving PCB, and 25 control cases who were given N2O/O2, pethidine, or a combination of both analgesics. The patients were strictly selected and allocated at random to either group. Local analgesia in combination with adrenaline was given at cervical dilatation 3-6 cm; 20 minutes were allowed to elapse from the administration of analgesia until registration of the contraction of the treatment period, to assure an established analgetic effect. PBC shortens Aa and Ad, but prolongs Ar. A + Da + Dr and Ad + Da are shortened while Dr is prolonged after PCB (Table IV). On the presumption that PCB inactivates a part of the lower uterine segment, the changes of Aa, Ar and Ad + Da were predictable. To determine the significance of adrenaline, another series of 21 patients were given PCB, injecting 0.25 per cent bupivacaine without adrenaline added to the solution. The duration of the phases before and after the block was compared. PCB without adrenaline brought about the same changes as it did with adrenaline, but the changes were smaller, only those of Aa, Ar, Dr and Ad + Da being statistically significant. The pressure curves of six patients receiving epidural block were examined using the same method as in the PCB and control groups. The changes typical of PCB did not occur after epidural block. The discovery of the six phases of the amniotic pressure curve, their change after PCB and the results of other investigators make possible a suggestion of the basic physiological processes that influence amniotic pressure during coordinated labour contractions. It is held that the form of the amniotic pressure curve can be explained in terms of contraction, relaxation, and propagation of a contraction and a relaxation wave.


Scanning electron microscopy of human reproductive physiology.


Morphology of the basal ganglia in Parkinson's disease. This work consists in part of volume measurements for the caudate nucleus, putamen and pallidum; and in part of a determination of cell-distribution and cell density in the corpus striatum from 9 paralysis agitans patients and 15 control persons from the Institute of Forensic Medicine. All 24 brains were sectioned on a specially constructed apparatus. For each of the individual sections, the size of the basal ganglia was determined by measurements of the section thickness with a capillary tube and area measurements were made by microscopic projection method combined with planimetric methods. For the first six control brains, the area measurements were also taken using point-counting method. The values thus obtained were used in the basic formula for a truncated cone and the volume of the basal ganglia for the individual hemispheres was calculated. The only exception was a single hemisphere where the volume of the basal ganglia was determined after dissecting out and weighing these structures. The results showed that the volume measurements of the corpus striatum and the pallidum in these two groups of brains were quite similar, when differences due to body height, age, and brain weight were taken into account. The volume of the basal ganglia decreased with age in both groups of brains and increased with brain weight. The shrinkage of the tissue as a consequence of the histological procedures was also determined. The shrinkage from fresh to formalin-fixed condition was determined by comparing the distance between the same two marked points in the fresh and formalin-fixed tissue. The shrinkage from the formalin-fixed condition to the completed histological preparation was determined by comparing the distance between known structural characteristics, as measured on photographs showing the formalin-fixed sections, lying beside a millimeter scale, with the same distance on the histologically treated preparations. The accumulated shrinkage in volume was 47.3%.


Twin pregnancy. Neonatal morbidity and mortality. The neonatal morbidity and mortality rate of 335 twin pairs born during the years 1965-1973 was investigated. 649 twins were born alive. 29 % of the twins were preterm. 31 % of the twins were small for date infants, and 41 % weighed less than 2 500 g. Mean birth weight was 2 590 g in A twins and 2 560 g in B twins. The neonatal mortality (0-28 days) was 7.1 %. The most common causes of death were the respiratory distress syndrome, intracranial haemorrhage and anoxia. Low one minute Apgar scores occurred more often in B twins than among A twins. Breech delivery gave low one minute Apgar scores more often than did spontaneous vertex delivery in both twins. Full term twins and infants weighing more than 2 500 g had fewer low one minute Apgar scores than the preterm infants and those with low birth weight. Neonatal disorders were equally common in both twins except the birth asphyxia and/or aspiration syndrome, which were more frequent in the B twins. The respiratory distress syndrome was diagnosed in 8 % of A twins and 12 % of B twins. Hypoglycaemia was recorded for 8 %, and hyperbilirubinaemia exceeding 15 mg % for 7 %. Infections occurred in 6 %. Transfusion syndrome was verified in 7 % and malformations in 6 %. Although mortality in twin pregnancies has declined, neonatal morbidity is very high. Twin pregnancies thus form a high risk group for obstetricians and pediatricians.


Cochlear action potentials in experimentally induced hypothyroidism in guinea pigs. Hypothyroidism was induced in guinea pigs by various methods. Using a new technique, electrodes were permanently implanted and action potentials aroused by different sound stimuli recorded and measured. The results obtained before and during the hypometabolic state were analysed and compared with those obtained after replacement therapy. A tentative attempt was made to extrapolate the changes in pattern and magnitude of the action potentials caused by the experimentally induced hypothyroidism, to the hearing disorders observed in patients with thyroid deficiency.


Oral treatment of menopausal symptoms with natural oestrogens. Experiences with a new series of oestrogens and oestrogen-gestagen combinations. A series of preparations containing 17-beta-oestradiol and oestriol in a proportion of 2 : 1 was studied with respect to their effects and side effects in 352 women in the menopause and postmenopause in a total of 2 101 woman months. In certain of the treated groups it was considered of value to produce regular bleeding, and in these patients the oestrogen therapy was complemented with noretisterone acetate during short periods. Both the subjective and the objective effects of the treatment were excellent. Side effects were rare and the treatment seems to have advantages over other oestrogenic compounds. No signs of disturbance of the liver function were observed. In contrast to the alkyl substituted steroids the natural oestrogens seem to have a normalising effect on the blood lipids.


Twin pregnancy. The role of active management during pregnancy and delivery. In a series of 335 twin patients delivered over 1965-1973, active management was promoted during the pregnancy and delivery. The twin diagnosis was made in the 33.7th gestational week on an average. The diagnosis was made prior to delivery in 83.0 % of the cases, and during 1971-1973 the diagnosis was made before the 32nd week of pregnancy in 40.2 % of the cases. The perinatal mortality (PNM) rates were highly significantly (p less than 0.001) lower, the birthweights of A and B higher (p less than 0.001), and the number of gestational weeks at delivery greater (p less than 0.001) in the group diagnosed during pregnancy than in the group in which the twins were not diagnosed until at delivery. 56.4 % of the patients stayed in hospital for more than 2 days during the pregnancy and 34.9 % for over 10 days. The average period of hospitalization was 11.3 days. The perinatal mortality (PNM) of both the A and the B infants was lowest in the group hospitalized for over 10 days. In the group which had stayed in hospital for over 10 days the mean birthweight of the A infants was higher by 100 g and that of the B infants by 94 g than in the group not hospitalized despite the early diagnosis of twins. The average duration of delivery was 9.3 hours. Active efforts were made to shorten the interval between the births of the two infants, and it was 17.5 minutes on an average. This interval was not, however, related to the PNM rate of the B twins. On the basis of our findings, we wish to emphasize particularly the importance of the early diagnosis of twins.


Twin pregnancy. A clinical study of 335 cases. In order to study the complications and therapeutic outcome of twin pregnancies, a retrospective survey was carried out in the University Central Hospital of Oulu. Twin deliveries during 1965-1973 numbered altogether 335, and their relative frequency was 1.7 %. The deliveries took place in the 37.2th gestational week on an average. The mean weights of the infants were 2590 g (A) and 2562 g (B). Perinatal mortality in the total series was 9.3 % (A 9.0 % and B 9.6 %). Pregnancy terminated before the 37th week in 29.2% of the cases. Perinatal mortality in this group was 27.0 %, while the corresponding value in the full-term group was 1.7 %. The perinatal mortality of primigravidas (14.1 %) was about twofold compared with that of the multiparas (7.2 %). Twin pregnancies were complicated by hyperemesis gravidarum, pre-eclampsia, anaemia, pyelonephritis and hepatosis more often than were the single pregnancies. The complications which contributed towards an increase of perinatal mortality included uterine bleeding in early and late pregnancy, hydramnion and superimposed pre-eclampsia. The complications generally associated with twin pregnancies and the increased perinatal mortality involved require that mothers with twin pregnancy, particularly primigravidas, should be subjected to intensified follow-up and treatment.


Type IV glycogenosis - a study of two cases. Liver biopsy materials of two siblings with type IV glycogenosis were studied by light and electron microscopy. Biochemical analysis was added using autopsy material in one of the two cases. Two kinds of polysaccharides were noted not only in the cardiac muscle, skeletal muscles, smooth muscles and reticuloendothelial cells, but also in the neutrophils and platelets. One was glycogen and the other was similar to amylopectin. Ultrastructurally, a large amount of fibrils, 60 A in width, glycogen rosettes and glycogen granules were detected in those cells. Branching glycosyltransferase deficiency was biochemically confirmed in one case examined.


Bacitracin production by the neotype; bacillus licheniformis ATCC 14580. A small but significant bacitracin production has been observed in the neotype Bacillus licheniformis ATCC 14580. This strain produces bacitracin only during the phase of rapid growth. The bacitracin production ceases before growth is completed, and the relationship between growth and antibiotic production was not influenced by different environmental conditions. The maximum titre produced by the neotype strain was about 1 i.u. bacitracin/ml. This maximum titre was not influenced by the environmental conditions which resulted in a great variability of the maximum titre of the known bacitracin producer Bacillus licheniformis ATCC 10716. In contrast to B. licheniformis ATCC 10716, the bacitracin production of the neotype B. licheniformis ATCC 14580 was not stimulated by Mn(II)ions. It is suggested that bacitracin may be incidentally overproduced by certain strains grown in certain environments. The controlled bacitracin production by the neotype is not consistent with the definition of secondary metabolites and the hypothesis concerning the function of secondary metabolites after growth of the producer organisms.


Cardiovascular effects of poisoning by hypnotic and tricyclic antidepressant drugs.


The serology of Bordetella bronchiseptica isolated from pigs compared with strains from other animal species. The serology of freshly isolated strains of Bordetella bronchiseptica from pigs and some other animal species was studied by the agglutination and agglutinin absorption tests. Differentiation was made between heat stable O-antigens and heat labile K-antigens. All the strains examined contained a common O-antigen (1). In addition, three heat stable antigens were detected. The heat labile antigens of freshly isolated strains were found to be very different. The major antigens 2 and 3 were not found in combination. A common weak K-antigen (1) was found in all strains. The pig strains were found to be serologically identical (0, 1, 2; K 1, 2). The same serotype was isolated from a rabbit. Another rabbit strain was found to be similar to a strain isolated from an SPF-rat (O, 1, 3; K 1, 3, 4). The antigenic pattern found in two cat strains was O 1, 3; K 1, 3. Typing of freshly isolated strains from pigs with monospecific factor sera confirmed that all the strains so far examined were serologically identical. This uniform serology hampers epidemiological studies of porcine bordetellosis by antigenic analysis. The occurrence of serologically different serotypes of B. bronchiseptica is of significance in the diagnostic bacteriology since the final diagnosis must be confirmed by a serological test.


Recurrent Aeromonas sepsis in a patient with leukemia. A case of recurrent sepsis due to Aeromonas hydrophila in a patient with acute myelogenous leukemia is reported. The patient's first infection leading to bacteremia followed contamination of a mosquito bite by stagnant water. After recovery from the first bacteremia, the patient again became septic with a second strain of Aeromonas hydrophila, which again responded to antimicrobial therapy. It is hypothesized that contamination of the local water supply may have led to the establishment of a gastrointestinal carrier state that produced the second bout of Aeromonas sepsis when the patient was markedly leukopenic. The importance of the oxidase test to differentiate Aeromonas species from members of the family Enterobacteriaceae is re-emphasized.


Restoration of effective hemopoiesis preceding suppression of leukemic clone in myeloblastic leukemia. A 63 year old Caucasian woman presented with myeloblastic leukemia and a hyperdiploid C group chromosome change in 10 per cent of marrow metaphases. Treatment iwth cytotoxic agents resulted in an increased percentage (52 per cent) of these hyperdiploid marrow cells. Furthermore, the marrow continued to show leukemic fearures morphologically and in culture. Despite the indications of persistence or progression of the hyperdiploid, putatively leukemic line at cessation of chemotherapy and for a period of time thereafter, remission was achieved and blood and marrow cell numbers one year after cessation of all treatment are normal. The hyperdiploid line is no longer detectable. This case raises questions concerning the mechanism whereby remission is attained in some cases of acute leukemia and is discussed in terms of the restoration of normal hemopoiesis eliminating the leukemic process.


Pulmonary mucormycosis caused by Cunninghamella elegans in a patient with chronic myelogenous leukemia. Cunninghamella elegans was cultured from autopsy materials of the infected lung of a patient with chronic myelogenous leukemia. The histologic sections revealed extensive growth of nonseptate, broad hyphae in and about the large and small arteries and veins, occluding the vessels. This case is believed to be the second in which human infection by C. elegans has been documented.


Craniomaxillary orthopedic correction with en masse dental control. Craniomaxillary (high-pull) traction is a well-established part of today's orthodontic armamentarium. It is useful in a wide range of problems involving excessive anterior and/or downward displacement of one or more components of the maxillary complex. Such growth-related problems are most amenable to correction during the active growing period; in fact, optimum improvement is often attainable only during this period. Attachment of these devices by means of cemented orthodontic appliances is limited in some developmental stages by the teeth available for banding. It is limited at all ages by the tolerance of the periodontal ligament of the attachment teeth. In  terms of over-all maxillary change, the locations of the banded teeth further restrict the orientation and application of therapeutic forces. A rigid splint precisely engaging all or part of the upper dentition expands the potential applications of this form of traction in terms of age range, force levels, and force orientation. This is basically an orthopedic applicance with concurrent orthodontic effects. In contrast to the gross destructive effects experienced in early applications of the Milwaukee brace, the application of force with this appliance can be planned to redirect maxillary growth and occlusal relationships from often progressively dysplastic patterns to a more harmonious over-all functional relationship among all facial structures. The resultant interplay of orthopedic and orthodontic effects makes close orthodontic supervision and care essential throughout the treatment and post-treatment periods. This is especially important because some of the orthodontic side effects may be unfavorable. Failure to anticipate and plan for control of these effects could be disastrous. Occasions for its use as the sole therapeutic measure are rare. The nature of treatment with this appliance is such that in most cases it must be used as a discrete stage of a comprehensive treatment plan, either before or after other orthodontic measures or both. It is poorly suited to simultaneous combination with other orthodontic appliances operating on the same teeth. Its value lies in careful coordination with the other phases, using each where and when it will be most effective. The cases reported here illustrate only the changes accomplished during such isolated treatment stages; they do not represent the total orthodontic effort required for these patients.


Ophthalmologic manifestations of granulocytic sarcoma (myeloid sarcoma or chloroma). The third Pan American Association of Ophthalmology and American Journal of Ophthalmology Lecture. The clinicopathologic review of 33 well-documented cases of granulocytic sarcoma on file in the Registry of Ophthalmic Pathology confirmed the facts that this tumor is encountered mainly in children, that boys are affected more frequently than girls, and that white Americans appear to be less vulnerable than other ethnic groups. While granulocytic sarcoma is a variant of granulocytic leukemia, the tumor may appear before, after, or concomitantly with hematologic evidence of leukemia. In the present series only four of the 33 patients were already known to have leukemia when they were first seen by an ophthalmologist for their orbital, ocular, or adnexal lessions. The Leder stain has proved extremely helpful in arriving at a definitive histopathologic diagnosis. Accurate diagnosis is important to prevent inappropriate medical or surgical treatment and to indicate the need for vigorous antileukemic chemotherapy. Prognosis at best is poor.


Diagnosis and treatment of maxillomandibular dysplasias. Skeletal dysplasia of the maxilla and/or mandible is responsible for prognathism or retrognathism. The severity of either condition is in direct proportion to the degree of dysplasia noted within each jaw. Mandibular prognathism is real or apparent. Some of the patients described in this article demonstrate this quite clearly when the jaws are analyzed individually and related to each other. A differential diagnosis is essential to determine whether the abnormality is in the maxilla or the mandible,  or both. When recognized early in the formative years, it permits the orthodontist to employ guidance and full therapy procedures in a treatment plan that is programmed to include surgical procedures specifically for the skeletal aberration to be corrected. The treatment skills of the orthodontist and  his knowledge of growth of the skeletal and dental structures aid in diagnosis and treatment planning in the areas of both orthodontics and surgery. Close cooperation between the orthodontist and the surgeon permits a more definitive resolution of the existing and potential skeletal and dentoalveolar abnormalities.


Arcial growth with metallic implants in mandibular growth prediction. The present investigation was undertaken to determine whether the Ricketts theory of arcial growth of the mandible can be put to practical use by the clinician to predict mandibular morphology. Eight subjects (six girls and two boys) were selected from the earliest implant samples at the Orthodontic Department of Emory University School of Dentistry. The initial cephalograms were coded and sent to Ricketts, and a 6-year manual growth forecast using the arcial method was requested. The final cephalograms were traced and compared. The three tracings (initial, prediction, and final) were superimposed over the metallic implants and presented on a case-by-case basis. The forecasts, in form, were clinically acceptable in five of the eight cases. In two of the cases (girls) (Cases 2 and 4) a hand-wrist radiograph to determine skeletal age would have improved their accuracy. The forecast in Case 2 was not acceptable. In view of our results in this small sample, the arcial method appears valid for prediction of amndibular growth; however, hand-wrist radiographs will improve the accuracy of short-range predictions of the amount of growth expected. For this reason, the orthodontist should constantly monitor his patients, watching for each individual to assert himself.


Adaptation of the mandible in children with adenoids. In a sample of lateral x-ray cephalograms of children with obstructing adenoids, a dorsal rotation of the mandibular ramus was found to characterize the facial skeleton. The mandibular body and the condylar process were not correspondingly rotated. The findings suggest that dorsal rotation of the mandible occurring in association with various pathologic processes could always be primarily a response to an encroachment of the pharyngeal space. A possible involvement of the clivus region, to a minor degree, was also indicated. The need for "tailormade" cephalometric methods in studies of specific problems is stressed.


AAO Foundation urges support from Association members.


Letter to the editor: More on facial pain symptoms.


Letter: Polycythemia vera and acute leukemia.


Letter: BCG therapy and urticaria.

Letter: BCG therapy and urticaria.


Polycythemia rubra vera progressing to Ph1-positive chronic myelogenous leukemia. Polycythemia rubra vera and chronic myelogenous leukemia are both myeloproliferative disorders and, as such, share certain clinical features. Although some myeloproliferative disorders may transform into others, conversion of polycythemia rubra vera to chronic myelogenous leukemia has been denied. We report here an elderly man with polycythemia rubra vera and a normal leukocyte alkaline phosphatase who developed chronic myelogenous leukemia with a low leukocyte alkaline phosphatase and a marrow karyotype of 45, X, Ph1-positive. In addition, we have collected evidence of two similar cases and thus conclude that, although uncommon, polycythemia rubra vera may on occasion progress to chronic myelogenous leukemia.


Splenectomy in the chronic phase of chronic granulocytic leukemia. Effects in 32 patients. Splenectomy in the chronic phase of chronic granulocytic leukemia was done in 32 patients, in 24 as part of a trial of elective splenectomy in early disease and in 8 because of thrombocytopenia preventing adequate therapy of the chronic phase. Patients with splenectomy had a median survival after diagnosis of 60 months. However, survival of patients operated on within 1 year of diagnosis was no different (median, 44 months) from that recorded in 120 consecutive Philadelphia chromosome-positive patients treated during the same time period (median, 42 months). After blastic transformation of disease, splenectomy patients survived slightly longer, responded more frequently to platelet transfusions, and avoided the morbidity of massive splenomegaly seen in 30% of patients treated with spleens retained. Response to blastic phase chemotherapy, however, was not improved. Prophylactic splenectomy in the chronic phase of disease did not influence survival but may ameliorate some complications of the terminal stages of illness.


Environmental influences on ascorbic acid requirements in animals.


Rectal pentothal sedation for selected patients.


Protective effects of ascorbic acid against toxicity of heavy metals. Toxicity of cadmium in the young Japanese quail rapidly produced moderate growth depression, hypogonadism in the male, decreased bone ash, severe anemia, alterations of "indicator" tissue levels of several essential inorganic elements, and marked histological abnormalities of the duodenum, bone marrow, adrenal medulla, and esophageal mucus glands. Cadmium appeared to have direct effects on zinc and iron, particularly iron (III), by decreasing intestinal absorption of these elements. Small amounts of dietary ascorbic acid were protective against many of the adverse effects of cadmium. The young quail proved to be a useful species for these studies. The experience with cadmium may have some facets that would prove useful in further studies of the effects of ascorbic acid on the toxicity of other metals.


Vitamin C and cigarette smokers.

Vitamin C and cigarette smokers.


Interaction with drugs and environmental chemicals. Effects of ascorbic acid on microsomal drug metabolism.


Reduction of gastric carcinogens with ascorbic acid. The formation of nitrite from nitrate was studied in potatoes incubated at room temperature. After 24 hours of incubation at 25 degrees, 112 ppm and 373 ppm of nitrite formed in homogenized cooked potatoes containing 284 ppm and 584 ppm of nitrate, respectively. In homogenized fresh potatoes incubated at 21 degrees and containing 284 ppm of nitrate, 103 ppm of nitrate formed within 24 hours. During the period of nitrite formation, nitrate levels decreased sharply, indicating that reduction of nitrate to nitrite occurred. Incubation at 2 degrees completely prevented nitrite formation in all cases. The formation of methylnitrosourea from added methylurea and nitrite was observed in potato incubated under simulated gastric conditions (37 degrees, pH 1.5). An ascorbate-nitrite mole ratio of 4 gave a 93% inhibition of methylnitrosourea formation. Ascorbate reacted directly with nitrite in potato incubated under identical conditions, yielding a 43% decrease in nitrite concentration. Ascorbate did not react with methylurea or the product, methylnitrosourea.


Effect of ascorbic acid on amine-nitrite toxicity.


A new self aspirating plunger.

A new self aspirating plunger. In another approach to the problem of aspiration before injection of local anesthetics, a new self aspirating plunger was designed. It is composed of similar materials currently in use. Its action is simply the elastic return of a temporarily stretched diaphragm in the center of the plunger. A gentle pressure and release will cause aspiration. No harpoon is used; therefore the cartridge can be more quickly loaded and changed. No special syringe is needed.Stanley C. Harris has said, "one of the most insidious dangers in therapeutics is the complacency which develops when undesirable reactions are infrequent. With local anesthesia, this complacency is intensified by the knowledge that local anesthetics are given intravenously by intention in certain medical procedures. However, when this procedure is employed, the patient is hospitalized, in an operating room with emergency equipment and drugs instantly available."(1)Dentists are aware of the possible consequences of intravascular injection of local anesthetics and know that these can range from lack of anesthesia to an unplesant experience or to a rare lethal one.(2-3) Case histories of complications of intravascular injection appear regularly in the literature. The presence of the anesthetic in the blood can easily be demonstrated.(4)


Ascorbic acid and cytochromes.

Ascorbic acid and cytochromes.


Cytotoxic aspects of the interaction of ascorbic acid with alloxan and 6-hydroxydopamine.


Comparative open and closed valve nitrous analgesia study in humans.


Instability and function: ascorbic acid and glutaminyl and asparaginyl residues.


Tissue changes induced by marginal vitamin C deficiency. Chronic marginal vitamin C deficiency in guinea pigs results in alterations in certain tissues that are quite different from those observed following acute deficiency. In autonomic ganglia, although changes observed in the organelles of some cells are similar to those seen in acute deficiency, the specific changes are the presence of large numbers of cilia in the cytoplasm of both ganglion cells and their associated neuroglia and the marked proliferation of collagen fibers in the extracellular spaces. The evidence presented points to a link between vitamin C and arteriosclerosis. One mode of interaction may be the effect of latent vitamin C deficiency on cholesterol metabolism. The data presented indicate important changes in the liver with marked increases of agranular endoplasmic reticulum. Together with the liver cholesterol studies, the indications suggest an increased cholesterol deposition in the liver. Light-microscopic sections of the aorta reveal alterations in many of these vessels ranging from endothelial proliferation to large, well-formed musculofibrotic arteriosclerotic plaques.


Some aspects of current vitamin C usage: diminished high-altitude resistance following overdosage.


Individual response to total spectrum of pain control in dentistry.


Effect of ascorbic acid deficiency on the permeability and collagen biosynthesis of oral mucosal epithelium.


Changes in ascorbic acid metabolism of the offspring following high maternal intake of this vitamin in the pregnant guinea pig. Guinea pigs were fed a control (0.05%) or a high (0.5%) ascorbic acid diet during the last half of pregnancy. When the pups were tested at 5 and 10 days of life the ones from the high-ascorbic-acid group demonstrated a marked increase in 14CO2 excretion, compared with the control pups, following an intraperitoneal injection of 14C-labeled ascorbic acid. When the animals were weaned to an ascorbic-acid-deficient diet signs of scurvy appeared earlier in the pups from the high vitamin C group and their survival was shorter. When excretion of labeled CO2 in both groups was correlated with the day of onset of scurvy signs, a linear correlation was found between these two parameters, suggesting that the earlier appearance of signs of scurvy in the experimental pups is secondary to an increased rate of ascorbic acid catabolism.


Effects of ascorbic acid on health parameters in guinea pigs. The maximal response of a selection of ascorbic-acid-dependent parameters to a range of intakes of ascorbic acid has been shown to occur at virtually one level of intake in the present experiments. Further, this response occurred with intakes that produced only 1/2 saturation or less of tissues with ascorbic acid. Excessive intakes did not enhance effects, and, as in the case of serum copper levels, may have a detrimental effect. In view of the known factors that may influence requirements and the intralaboratory variability in experimental conditions, the more reasonable approach to the interpretation of dose response data is likely to relate the response to the accompanying degree of tissue saturation, rather than to an absolute level of ascorbic acid intake.


Ascorbic acid in cholesterol and bile acid metabolism. Latent chronic ascorbic acid deficiency provokes in guinea pigs a metabolic disorder in the liver, causing an impaired cholesterol transformation to its principal catabolic product, bile acids. This metabolic disorder induces hypercholesterolemia and accumulation of cholesterol in the liver and slows the release of cholesterol from the circulation. Ascorbic acid probably intervenes into the biosynthesis of bile acids at the stage of 7 alpha-hydroxylation of the cholesterol nucleus. High doses of ascorbic acid significantly stimulate cholesterol transformation to bile acids in guinea pigs and decrease plasma cholesterol concentration in humans.


Proposed uses of ascorbic acid in prevention of bladder carcinoma.


Biological variation in ascorbic acid needs.


Human requirements and needs. Vitamin C status: methods and findings. Although vitamin C nutritional status in man may be determined on the basis of dietary intake findings and on clinical signs of a dietary deprivation, biochemical measurements represent the most objective approach. Without the availability of a functional biochemical procedure that relates to vitamin C status, information concerning inadequacies in this nutrient has been derived mainly from measuring ascorbate levels in serum (plasma), leukocytes, blood, and urine. The measurement of serum levels of ascorbic acid is the most commonly used and practical procedure for determining vitamin C nutritional status in individuals or population groups. Although leukocyte ascorbate levels provide information concerning the body stores of the vitamin, the measurement is technically more difficult to perform, and, hence, its use is largely confined to clinical situations as an aid in the diagnosis of scurvy. The clinical diagnosis of scurvy can be aided also by information on the urinary levels of ascorbic acid and the use of vitamin C loading or saturation tests. With recognized limitations, ascorbic acid can be measured in biological samples with the use of automated or manual colorimetric and fluorometric procedures. Nutrition surveys conducted in Canada and the United States have indicated vitamin C deficits among certain population groups.


Ascorbic acid and athletic performance.

Ascorbic acid and athletic performance.


Ascorbic acid deficiency in clinical disease including regional enteritis.


Relationships of ascorbic acid to pregnancy, and oral contraceptive steroids. The 1974 RDA is 60 mg per day for pregnant women and 80 mg per day for lactating women. In the present study an attempt was made to simulate this intake in the guinea pig and study reproduction performance in relation to guinea pigs fed chronically low and high levels. In animals that conceived and carried the young to term, all 3 dietary levels of ascorbic acid appeared to be adequate for maintaining viability of fetuses and of offspring, and for growth of offspring during the nursing period. The chronically low intake level was not adequate for growth after weaning. The control group was superior to the chronically low-intake group but inferior to the high-intake group in conceiving, producing litters, and carrying litters to term. The level of intake in the control group was inadequate to maintain tissue stores. Even the high intake was inadequate to maintain some tissues at saturation levels. The results suggest that the requirement for ascorbic acid during pregnancy and lactation has been markedly underestimated.


Metabolism of ascorbic acid. Introduction: overview of ascorbic acid metabolism.


Liquid chromatographic analysis of ascorbate and ascorbate-2-sulfate.


The recommended dietary allowances for ascorbic acid.


Utilization of ascorbic acid in fish.

Utilization of ascorbic acid in fish.


Current status of vitamin C and future horizons.


Placental alkaline phosphatase: regulation of expression in cancer cells.


Structural studies on the carcinoembryonic antigen.


Detection of carcinoplacental alkaline phosphatase by thin layer polyacrylamide gel electrophoresis.


Heterogeneity of carcinoembryonic antigen. II. Monosaccharide composition of concanavalin A-reactive and -nonreactive CEA. Monosaccharide compositions of Con A-reactive CEA (CEA-M) and Con A-nonreactive CEA (CEA-P) separated from two different samples of CEA were analysed by gas liquid chromatography. It was revealed that all CEA subfractions possessed N-acetylglucosamine, fucose, and galactose residues. One out of 4 subfractions did not contain sialic acid and another one lacked glucose in its carbohydrate moiety. N-acetylgalactosamine was not detected in measurable amount in any of the 4 subfractions. A large amount of mannose was found in CEA-M, but only a small amount in CEA-P.


Antiplacental ferritin antiserum for cancer diagnosis.


Individual differences in early semantic and syntactic development.


Radioimmunoassay of serum ferritin in patients with malignancy.


Mother-infant exchanges: the epigenesis of conversational interaction.


Psychopathology and atypical language development.


Perception and production in a visually based language.


The ontogeny of cerebral dominance.

The ontogeny of cerebral dominance.


Cerebral asymmetries in humans are due to the differentiation of two incompatible processes: holistic and analytic.


Linguistic competence in aphasia.

Linguistic competence in aphasia.


The language-impaired child: linguistic or cognitive impairment?


Vocalizing in unison and in alternation: two modes of communication within the mother-infant dyad.


On the nature of language from the perspective of research with profoundly deaf children.


Proceedings: Morphology of liver glycogenosis.


International symposium on cancer nursing.


Proceedings: Ondine's curse: a pathogenetic mechanism in pulmonary hypertension.


Surgical management of osteogenic  sarcoma of the mandible. Osteogenic sarcoma is the most common malignant tumor of the mandible. It is less aggressive than osteogenic sarcoma of the long bones, and mortality is often due to local persistence or intracranial extension. We report such a case to emphasize that disarticulation of the mandible is necessary, since clinical and pathologic evaluation of tumor extent may be impossible. Except for parasymphysial lesions, disarticulation with midline hemimandibulectomy and frozen section assessment of all margins is recommended.


Parosteal osteogenic sarcoma of the mandible, Existence masked by diffuse periodontal inflammation. A 38-year-old man was in a state of poor oral hygiene, with multiple broken carious teeth and diffuse inflammatory hyperplasia of the gingival tissues. A mandibular, alveolar soft tissue mass in the premolar-molar region was noted on the right side, in continuity with the gingival hyperplasia. Biopsy of the lesion ruled out a diagnosis of squamous cell carcinoma. The patient underwent extraction of his teeth, and all hyperplastic tissues including the tumefaction were excised. Five months later, the patient had a recurrent mass in the same location that was removed via hemimandibulectomy. The mass was diagnosed as a parosteal osteogenic sarcoma.


Take me to your leader: the psychiatrist in the health care system.


Psychosocial reactions to scientific change.


Dimensions of abnormal illness behaviour.


The management of pathological grief.

The management of pathological grief. Earlier descriptions of pathological grief are reviewed. From the study of recently bereaved widows major forms of pathological grief are outlined. These are suppressed or inhibited grief and distorted grief, including forms with extreme anger or extreme guilt. Other grief variants are noted. The management of pathological grief is outlined; specifically the encouragement of the expression of suppressed affects especially sadness, anger and guilt; as well as the going over of memories and feelings to do with the lost relationship. Consideration is given to: the establishment of the therapeutic contract; the specific exploration of the response to the death and the pre-existing relationship; resistances; interpretation of defences; assessment of progress of mourning; social network factors; termination; and transference and counter-transference.


Obesity and anorexia nervosa: psychosocial aspects.


A psychophysiological distinction between types of depressive states.


A new application of closed group psychotherapy in a public psychiatric hospital. This paper describes an intensive group psychotherapy treatment program in a public psychiatric hospital to which patients with severe personality disorder are referred. A unique structure within the patient/staff community is described concerning the inter-relationships of the closed psychotherapy groups and the relationships between the groups and staff within the broader therapeutic milieu. The regular arrival and departure of the closed groups serves to activate relevant latent instinctual conflicts which are of significance in personality disorder. The advantages of this approach to treatment of personality disorder are discussed and the results of evaluation of progress of the unit's first eleven closed groups are presented.


Medico-legal aspects of automatism.

Medico-legal aspects of automatism.


Letter: Attempted suicide.

Letter: Attempted suicide.


A modified nuclear DNA polymerase in a case of acute lymphoblastic leukemia.


Schistosomal nephropathy? I. Preliminary studies of a patient with schistosomiasis mansoni and glomerulonephritis in Puerto Rico.


Letter: Clinical endodontology.

Letter: Clinical endodontology.


Letter: Postgraduate education and training in general practice.


Letter: Student admissions.

Letter: Student admissions.


A right intraventricular conduction defect concealed by a left anterior hemiblock plus an anterolateral myocardial infarct.


Letter: Claims for fluoride toothpastes.


Letter: A fluoride mouthrinsing scheme in Portsmouth.


Letter: State abuse of dentistry.

Letter: State abuse of dentistry.


Repeat freeze cycles in cryosurgery of oral tissues.


Myelomatosis. A case report.

Myelomatosis. A case report.


A method for sharpening probes.

A method for sharpening probes.


Treatment of acute lymphoblastic leukemia in adolescents and a-dults: A retrospective study of 41 patients (1970-1973). During the period from January 1970 until December 1973, therapy was started in 41 previously untreated adolescents and adults with acute lymphoblastic leukemia. Induction therapy was started with vincristine and prednisone in all patients, resulting in complete remission in 19 and death due to infection during the first month in one case. After 3 wk on these two drugs, the addition of daunorubicin was required in the remaining 21 patients. Fifteen of these obtained remission, one died during induction therapy, and five patients were unresponsive to this therapy, as well as to all subsequent induction schemes. The overall remission rate was 83%. Significantly higher initial leukocyte counts were found in the group treated with vincristine, prednisone, and daunorubicin. Meningeal leukemia prophylaxis, by either periodic methotrexate injections given intrathecally or a combination of cranial irradiation and intrathecally administrated methotrexate, was administered in 29 therapy responders. The median duration of complete remission obtained with various maintenance therapy schemes was 13 mo. No differences were seen in the results obtained in patients between 14 and 20 yr of age and older patients. Twenty-two patients relapsed within 2-37 mo. Relapses were confined to the central nervous system in two cases, to the bone marrow in 18, and to the bone marrow and CNS simultaneously in two. A second remission was obtained in 17 cases (77%). The median survival time of the whole group was 27 mo, as compared with 32 mo for therapy responders and 7 mo for the nonresponders. The percentage and duration of remission and the survival time in our group of adolescents and adults were comparable to those currently being achieved in other centers, but not as good as those reported for children treated with the same protocols.


Antibody responses to leukemia-associated antigens during immunotherapy of chronic myelocytic leukemia. We have studied immunologic reactivity to leukemia-associated antigens in patients with chronic myelocytic leukemia (CML) treated with chemotherapy and adjunctive immunotherapy. All patients were immunologically competent as measured by skin test reactivity to dinitrochlorobenzene. Immunotherapy consisted of allogeneic irradiated leukemic myeloblasts injected intradermally, with BCG vaccine (Research Foundation, Chicago, Ill.) given by multiple puncture at the same site. 10(9) cells plus BCG were given weekly for 4 wk, and 10(8) cells plus BCG were given at monthly intervals thereafter. Eight patients judged clinically to be in the stable phase of their disease developed circulating antibody against the immunizing blast cells demonstrable by cytotoxicity and immunofluorescence assays. The antibody also showed reactivity against a panel of myeloblasts (12 paients) but not against the corresponding remission lymphocytes (five patients) or normal lymphocytes (20 donors). In two cases the antibody showed reactivity against the patient's own leukemic blasts. Seven of these eight patients have maintained a steady clinical course ranging from 20 to 40 mo, while one entered the blastic phase and died. Six patients were judged to be in the aggressive phase of CML because of progressive leukocytosis and splenomegaly or increasing myeloblastosis; five died an average of 16 mo after diagnosis. Humoral antibodies were not detected in these patients after repeated courses of BCG and allogeneic leukemic cells. We conclude that specific active immunotherapy of patients with CML can abet the production of humoral antibody against blast cell antigens and that this response may be impaired during the aggressive phase of the disease.


Intensive leukapheresis as initial therapy for chronic granulocytic leukemia. Intensive leukapheresis has been used as the initial treatment of chronic granulocytic leukemia (CGL) in six patients. The number of leukaphereses ranged from 3 in 7 days to 13 in 39 days (mean, 8 in 22 days). The procedures were well tolerated, and in all patients there was improvement in hematologic values, in most cases with considerable reduction in the peripheral leukocytosis and thrombocytosis and in the proportion of immature granulocytic cells in the circulation. Splenomegaly decreased considerably in the four patients who had more than four leukaphereses. Symptoms of sweating, malaise, and pain due to splenomegaly were rapidly relieved. Problems due to hyperuricemia did not occur, but four patients required blood transfusions for correction of anemia. This method of initial treatment of CGL appears to give more rapid relief of symptoms than does conventional chemotherapy; it incurs no risk of hyperuricemia and lessens that associated with thrombocytosis. In addition, large quantities of granulocyte-rich plasma are made available for the treatment of infections in neutropenic patients. Intensive leukapheresis deserves more widespread evaluation as the initial treatment of CGL.


Osmotic behavior of normal and leukemic lymphocytes. The response of normal human peripheral blood lymphocytes to a hypotonic environment may be divided into two phases: the cells first exhibit rapid osmotic swelling, followed by a slower shrinking phase, during which they regain their initial physiologic volume. This osmotic behavior is characteristic of most mammalian and avian nucleated cells so far examined. The normal human blood lymphocyte, however, shows the most rapid recovery phase (5 min). Lymphocytes from chronic lymphatic leukemia patients, in comparison, show a strikingly slower rate of return to their initial isotonic volumes. The mechanism underlying osmotic cell volume regulation and its significance are discussed.


Nodular fasciitis causing unilateral proptosis. A case report of an unusual case of nodular fasciitis in the orbit presenting with unilateral proptosis is described, and the radiological features are outlined. The histological features are discussed and the benign nature of the lesion stressed. Nodular fasciitis arising in the orbit and presenting as unilateral proptosis has not previously been reported in the literature.


Ultrastructural histochemical alteration of the plasma membrane in chronic myelocytic leukemia. Ultrastructural histochemical evaluation of the surface of normal human blood and bone marrow cells exposed to the pyroantimonate-osmium (PAO) reaction indicated the selective binding of pyroantimonate to certain cations (calcium, magnesium, and possibly sodium) associated with the plasma membrane of neutrophilic leukocytes and their developmental forms. Other leukocytes and their precursors did not exhibit plasma membrane PAO reactivity. The extent of surface binding was related to cell maturity, with maximal labeling evident in the mid and late promyelocytes; decreased binding occurred with subsequent maturation while myeloblasts were nonreactive. This study was initiated to ascertain if histochemical surface modifications of neutrophilic cells occur in certain myeloproliferative disorders. In this regard, we have been able to demonstrate a distinctive defect in the plasma membrane PAO binding characteristics of the leukemic cells in chronic myelocytic leukemia (CML). Limited binding of pyroantimonate to the plasma membrane of the leukemic cell series in four patients with CML contrasted with that of the normal granulocytic cell series and the neutrophilic cells seen in myelomonocytic leukemia (two patients), myelofibrosis (one patient), and acute myelocytic leukemia (three patients). Comparison of surface PAO reactivity of neutrophilic cells in all stages of maturation in two patients with CML in blast crisis revealed that, in the patient with 30% circulating blast cells, PAO reactivity was identical to that noted in CML, while in the patient with 80% circulating blast forms, the PAO reactivity of the maturing neutrophilic cells more nearly resembled that observed in neutrophilic cells from normal individuals. Many neutrophilic cells from patients with myelofibrosis and myelomonocytic leukemia and from one patient in severe blast crisis had large surface deposits of pyroantimonate considered to reflect increased membrane-associated reactive cation.


Chronic myelogenous leukemia presenting in the blastic phase and its association with a 45 XO Ph1 karyotype. A 58-yr-old male patient presented in the blastic phase of chronic myelogenous leukemia (CML). Cytogenetic studies revealed a 45 XO Ph1 chromosome pattern in bone marrow cells during a short remission and again in the blastic phase of the disease. The patient expired 8 mo following diagnosis. The blastic phase of CML can stimulate acute myelogenous leukemia (AML) clinically and hematologically; CML can be differentiated by the presence of the Ph1 chromosome and the stigmata of CML. Absence of the Y chromosome from the bone marrow in CML is a recently described finding. Previous reports indicating the prevention of the blastic phase in patients with this karyotype could not be confirmed by our or other recently reported cases.


Educating the profession for high-quality care.


Improving the quality of health care: a skeptic's view.


Formal quality-assessment and utilization-review programs: their effects on the basic transactions of medical education.


Effect of quality control programs on the organizational structure of the hospitals.


Long-term consequences of professional review.


Supervision of health-care watchmen--by whom?


Quality for whom? Effects of professional responsibility for quality of health care on equity.


The future of quality assurance in health care: next steps from the perspective of the federal government.


Quality of care assessment in the light of the relation between doctor and patient.


The role of professional standards review organizations in the assessment of quality.


Evaluation of the care of patients: Codman revisited.


A consumer perspective on the professional responsibility for the quality of health care.


Ambulatory care review: a neglected priority.


Measuring and evaluating hospital and medical care.


The young physician versus the aging system.


Quality assessment and ambulatory care.

Quality assessment and ambulatory care.


Evaluation and improvement of the quality of care at a municipal hospital--a critique.


Educating the health professions for high-quality care: nursing education.


The professional responsibility for the quality of health care. A discussion of methods. Panel discussion.


Daunorubicin, cytosine arabinoside, 6-mercaptopurine riboside, and prednisolone (DCMP) combination chemotherapy for acute myelogenous leukemia in adults. Thirty-seven adults with acute myelogenous leukemia (AML) were treated with a combination of daunorubicin, cytosine arabinoside, 6-mercaptopurine riboside, and prednisolone (DCMP) for remission induction. Twenty-three of 37 patients (62.2%) achieved complete remission, three, partial remission and 11, failure. Patients with prior therapy responded as well as patients without it. The median survival time of the patients who received DCMP for their initial remission induction therapy was 10.3 months and that of the patients who obtained complete remission was 17 months. Complete remission occurred in 21 out of 28 patients (75%) less than 40 years old but in only two out of nine patients (22.2%) more than 40 years old. The most common toxic effects were severe myelosuppression and liver function abnormalities. DCMP therapy is an effective remission induction chemotherapy for adults with AML.


Acute lymphoblastic leukaemia: cyclical chemotherapy with three combinations of four drugs (COAP-POMP-CART regimen). Forty-two adults and children with previously untreated acute lymphoblastic leukaemia (ALL) were entered into a programme of chemotherapy in which three combinations, each of four drugs were administered in a predetermined cyclical rotation together with cranial irradiation and intrathecal injections of methotrexate. Forty-one patients (98%) entered remission and no patient developed neuroleukaemia. Relapse of ALL occurred in 10 patients, and three patients died during remission, while eight patients stopped treatment after two and a half years and have remained in remission for two to 26 months. Comparison of remission and survival experience in this mixed group of children and adults with the experience of children treated at Memphis and in the Medical Research Council's UKALL-I trial showed no significant differences. On the other hand, analysis by prognostic factors showed that neither age nor blast cell count at presentation had any adverse effect in patients treated in this study. No relapses occurred in nine patients with blast cell counts greater than 20 x 109/1 at presentation. This regimen is effective treatment for ALL and may be of special value in patients with poor prognoses. The regiment has not as yet proved superior for the treatment of children with ALL who do not have adverse prognostic features.


Unfavorable prognosis of acute leukemia in infancy. Pretreatment characteristics of 48 infants (under 2 years of age) with leukemia treated over a period of 18 years at a single institution were studied in relation to response to therapy, extramedullary involvement, and survival. In order to provide a basis of comparison, 45 of the infants were each paired with an older (2-9 years of age) leukemic child, who had the same race, and disease type, who was treated within the same period of time and received similar suportive care and chemotherapy, and when possible, was of the same sex. The overall median survival times of infants and their pairmates were 211 days and 445 days, respectively. Initial status of the spleen was the single significant factor in relation to the length of survival. Median survival time for infants with splenomegaly was 186 days compared to a median survival time of 414 days for infants without splenomegaly. The complete response rate was 75% for infants and 80% for the pairmates. Median duration of remission was 84 days for infants and 280 days for their pairmates. Initial peripheral leucocyte count was significantly related to the duration of remission; patients with very high leucocyte counts had the shortest remissions. The duration of remission increased throughout the period covered by this study, however, prognosis relative to pairmates remained poor. Central nervous system leukemia occurred in 44% of infants and 40% of the pairmates; incidence of CNS leukemia was much higher (70%) in infants under one year of age than in infants one year old (37%). Extramedullary leukemia occurred at other sites in 46% of the infants and 31% of the pairmates. The only pretreatment characteristic of prognostic importance for predicting extramedullary involvement was the patient's age at diagnosis.


"Skip" metastases in osteosarcoma.

"Skip" metastases in osteosarcoma. Careful study of 40 cases of osteosarcoma without evidence of multifocal disease, pulmonary metastasis, or history of exposure to predisposing factors has given histologic evidence of microscopic foci of osteosarcoma separate from the primary focus of osteogenic sarcoma. These "skip" lesions are to all pathologic examination completely separate from the primary focus of osteogenic sarcoma. They are more often found proximal to the primary, both intraosseously and transarticularly. Histologically, these "skips" represent areas of osteosarcoma which in many cases are a less-differenitated form of the tumor. The natural history  of such tumors with "skips" following ablative surgery is an increased incidence of local recurrence and subsequent pulmonary metastases.


Initial features and prognosis in 363 children with acute lymphocytic leukemia. The relationship of a variety of initial features and the outcome of therapy was analyzed for 363 children with acute lymphocytic leukemia (ALL). All had entered "total therapy" studies between 1962 and 1971. The standard for comparing outcome of therapy was whether patients with a given feature attained or exceeded the median duration of complete remission, hematologic remission or survival for the group. The results showed that, in general, the more massive or extensive the disease at diagnosis, the poorer the outcome. Factors associated with a significantly poorer prognosis included: initial leukocyte count above 100,000/mm; spleen enlargement greater than 5 cm; mediastinal involvement and early CNS involvement. Children over 10 years old at diagnosis and Negro children also had a poor prognosis. From another viewpoint features were examined for patients who attained at least 3 years of continuous complete remission. This confirmed some earlier findings and, in addition, showed that children under 2 years of age at diagnosis or with hepatomegaly over 5 cm were less likely to attain this goal. With the exception of early CNS involvement, however, patients with excellent responses to therapy were found with each factor of poor prognosis. Two major factors were not analyzed because their relationship to prognosis is generally accepted: therapeutic differences and acute nonlymphocytic leukemia.


Prognostic factors in osteosarcoma. A review of 20 year's experience at the University of Pittsburgh Health Center Hospitals. The histologic and clinical characteristics of 54 patients with osteosarcoma are reviewed. The association of rapid linear bone growth with the occurrence of this tumor is confirmed, and evidence for increased growth in these adolescent patients is presented. A significant increase in female survival is seen in this study, and the literature relevant to gender and survival is reviewed. A histologic characterization of six predominant tumor patterns is presented with correlation to survival. Increased survival is seen with two specific histologic patterns, but there is great variability in the histology and sampling of osteosarcomas, and the series is small.


Successful control of systemic Aspergillus niger infections in two patients with acute leukemia. The diagnosis and successful control of systemic Aspergillus niger infection in 2 adult patients with acute leukemia is reported. During induction therapy, the first patient developed pulmonary infiltrates, skin lesions and abnormal liver function tests. Aspergillus niger was found on skin and liver biopsy. This patient was successfully treated with Amphotericin B and granulocyte transfusions and he remains in remission. The second patient developed a pneumonitis and adynamic ileus with positive sputum and stool cultures for Aspergillus niger. The infection only responded to Amphotericin B and granulocyte transfusions and the leukemia to cytoreductive chemotherapy. The patient later relapsed and died after a febrile illness. Fungi morpholocially consistent with Aspergillus were found in the liver at autopsy. Infection with A. niger is rare even in this patient population; however fungal infections have become an increasing problem. The need for a high index of suspicion, especially when an infection is unresponsive to antibacterial antibiotics, the various diagnostic tools, and the need for aggressive therapy are stressed. Amphotericin B is the chemotherapy of choice but may be insufficient in a severely neutropenic host where the simultaneous use of granulocyte transfusions might be lifesaving.


Remission maintenance of acute nonlymphoblastic leukemia with BCNU (NSC-409962) and cyclophosphamide (NSC-26271). Thirteen of 29 patients with acute nonlymphoblastic leukemia achieved complete remission with cyclophosphamide, cytosine arabinoside, and vincristine, and remissions were maintained with a combination of BCNU and cyclophosphamide. The maintenance drugs (200 and 1000 mg/m respectively) were given at 8-week intervals intravenously. Only six of the 13 patients achieving a complete remission have relapsed. The projected median duration of complete remission is 65 weeks and of survival from diagnosis is 144 weeks. These remission and survival durations compare favorably with the results achieved using other forms of remission-maintenance therapy. The advantage of our form of maintenance therapy is that only overnight hospitalization is required at 8-week intervals.


Commentary: Cancer chemotherapeutic agents and carcinogenesis.


Acute myeloid leukemia in the adult.

Acute myeloid leukemia in the adult.


Behavior and achievement of cleft palate children. Forty-four cleft lip and palate/palate only children were individually matched with forty-four normal school children on the basis of sex, age, grade, intelligence and socioeconomic status. All children received behavioral ratings by classroom teachers, and achievement test scores were obtained. The cleft children were rated by teachers as displaying significantly greater inhibition of impulse (internalizing behavior). Cleft children also were significantly lower on overall basic skills achievement test scores. It was suggested that cleft children may be responding to the social-behavioral environment which may include negative social responses from others.


"Nasalance" vs. listner judgements of nasality. In this article, judgements of nasality from sound field recorded utterances of 23 children with repaired palatal clefts are compared with "nasalance" values derived from TONAR II analyses of parallel sound separated recordings. For the nasality judgements, the sound field recordings were presented in forward reproduced mode to 20 "naive" listeners and in backward reproduced mode to 10 naive listeners. A four-level task progression was followed in each mode of presentation: sorting the responses by "normal" or "abnormal" nasality, ranking them by severity of nasality, classifying them within five degrees of nasality, and, finally, assigning a discrete score to the magnitude of nasality perceived in each recording. Scores from the individual judges were highly variable, especially in the first listening task. They were consitently more variable when nasality was judged from backward reproduced recordings. As the listeners gained experience and as the listening tasks demanded more precision in nasality judgements, variability was reduced. Correlations computed between the nasality ratings and nasalance measurements increased and variability decreased. Highest agreement between physical and perceptual measurements was found when variability among the judges was reduced by pooling the scores and comparing the mean scores of nasality with the nasalance scores. Using this procedure, a correlation of .91 was obtained between listener judgemental scores of forward reproduced speech and nasalance scores. Under these conditions, the instrumental score could apparently account for over 80 per cent of the variability in the listener judgements of nasality. From the findings of this study, it was concluded that listeners without prior training are capable of judging nasality reliably and that nasalance scores provide a valid correlate of perceived nasality. The use of backward reprodeced recordings was questioned as a means of assessing nasality.


A comparative study of results of the von Langenbeck and the V-Y pushback palatoplasties. The incidence of velopharyngeal competence noted in 267 cleft palate patients following palatoplsty has been reviewed. Comparisons have been drawn with regard to the cleft type and the surgical technique performed. Since there were relatively small numbers of subjects in some categories, differences in age at last examination between the von Langenbeck and V-Y palatoplasty groups, some patients were very young at time of evaluation, and a number of different surgeons at different levels of training and experience performed the surgery, the differences in velopharyngeal competence found should be viewed as trends and this report as preliminary. In general, there was a trend toward smaller percentages of patients attaining acceptable velopharyngeal competence as the severity of the cleft increased. Of those with clefts of the soft palate only 86 per cent achieved competence. Among those patients with clefts of the palate only, 67 per cent achieved competence, whereas only 57 per cent of those with clefts of the lip and palate were able to do so. When comparing all cleft types, the V-Y palatoplasty resulted in a significantly higher percentage of velopharyngeal competence (74 per cent) than did the von Langenbeck method (56 per cent), although the data for the V-Y group are probably less reliable than those for the von Langenbeck group. In the soft palate only category, the results were slightly better with the von Langenbeck technique, though not significantly so. In all other cleft types, the results with the V-Y method were better than those with the von Langenbeck.


In-vitro fusion of the human secondary palate.


Survey of publications for parents of cleft palate children: a preliminary report. In summary, these findings indicate that the general quality of the publications for parents of cleft palate children is probably mediocre and that both parents and speech pathologists tend to agree on assessments to this effect. The publications which appear to be most widely used are not necessarily those which appear to be the best available. Attention needs to be given to the design and content of future parent publications which should probably be written with knowledge of the parents' changing concerns over time. Since parent publications are used by many professionals involved in clef palate habilitation and there is no information about their opinions of the quality of these publications, additional work on this problem is planned for the future.


Repeated superiorly based pharyngeal flap operation for persistent velopharyngeal incompetence. A secondary pharyngeal flap procedure, superimposed, on the primary flap, is described after having successfully improved the speech of the three patients on whom it has been used. The raising of a secondary flap is made possible by the fact that minimal scarring occurs from previous pharyngeal flap surgery and also because of the presence of a muscle layer. The combination of factors leading to further reduction in the size of the velopharyngeal lumen is discussed. This operation offers some measure of hope for the not insignificant number of patients who have been left with poor speech after pharyngeal flap surgery and supports the recent work of Cosman and Falk (2).


Spheno-pharyngeal meningocele and cleft palate. Case report with 12-year follow-up. A rare congenital anomaly consisting of a spheno-pharyngeal meningocele and cleft palate is presented. The repair of the meningocele was accomplished through an intra-oral transpalatal approach. A primary pharyngeal flap was used to accomplish the repair of the cleft palate. Fortunately, there were no important anomalies of the central nervous system. Twelve years later, the patient functions normally and speaks well. The only remaining symptom of midline craniofacial dysmorphia is a mild hypertelorism.


Letter: For Parents of New Born Babies with Cleft Lip/Palate pamphlet.


Cleft of the nasal ala. Case report.

Cleft of the nasal ala. Case report.


Hepatosplenomegaly of unknown etiology.

Hepatosplenomegaly of unknown etiology.


Experimental studies of the antitumor activity of amygdalin MF (NSC-15780) alone and in combination with beta-glucosidase (NSC-128056). Amygdalin MF was evaluated alone and in combination with an activating agent, beta-glucosidase, against three transplantable rodent tumors; Ridgway osteogenic sarcoma, Lewis lung carcinoma, and P388 leukemia. In dose-response studies up to the LD20 in normal mice, amygdalin MF alone did not demonstrate significant antitumor activity against any of these three tumor systems. Similarly, at doses not exceeding the LD10 in normal mice, amygdalin MF plus beta-glucosidase did not demonstrate antitumour activity against any of these three tumor systems. Potentiation of the lethal toxicity of amygdalin MF by beta-glucosidase was observed in all studies where the two agents were given in simultaneous combination.


Applied behavior analysis in the treatment of childhood feeding problems. This paper discusses behavioral mismanagement as a cause of feeding problems in children and reports the case of a six-year-old handicapped boy who was subsisting almost entirely on pureed foods at the time of his referral. Treatment with applied behavior analysis resulted in his acceptance of food normal for his age, and at follow-up 12 months after treatment the variety of foods eaten and the nutrient intake were virtually normal for his age. The authors discuss the frequent occurrence of feeding problems in children and their possible causes. They propose that such problems constitute a clinical entity and suggest a preliminary classification system for them.


Reconstitution of the cerebral cortical mantle in shunt-corrected hydrocephalus. The purpose of this study was to ascertain the sequence of events and the cellular constituents involved in reconstituting the cortical mantle after ventricular shunting. The subjects were severely hydrocephalic adult cats. After insertion of a shunt, the ventricular system rapidly returned to normal size and there was gross reconstitution of the cortical mantle. However, there still remained in the cortical mantle many of the histological changes seen before insertion of the shunt. The effect of hydrocephalus is mainly upon axons in the periventricular white matter. The axons become stretched and finally disrupted, resulting in disintegration of the surrounding myelin. In the absence of axons, remyelination cannot take place. It would seem, therefore, that prompt reversal of hydrocephalus is necessary in order to preserve the anatomical and functional integrity of the brain.


Serological surveillance of children with CSF shunting devices. A naturally-occurring, age-related rise in titre of antibody to Staph. albus in both hydrocephalic and non-hydrocephalic children is demonstrated in this report. In view of this finding, the value of serial determinations of antibody titre in children with shunts is discussed in terms of an organised surveillance programme.


Cerebrospinal fluid dynamics in megalencephaly. Macrocephaly is one of the signs most commonly used in the diagnosis of hydrocephalus. Two children are reported who presented with macrocephaly. The results of neurological examination were normal apart from delay in mental development. Head circumferences were above the 98th percentile. Air studies showed mildly dilated ventricles with no obstruction, and ventriculolumbar perfusions indicated normal rates of cerebrospinal fluid formation and absorption. At seven years of age the children were mildly mentally retarded, with head circumferences above the 98th percentile. In the girl the ventricles were still mildly dilated but in the boy they were normal. It is concluded that the macrocephaly in these two children was the result of progressive megalencephaly and not of abnormal ventricular enlargement (hydrocephalus).


Dandy-Walker syndrome associated with congenital heart defects: report of three cases. Three cases of Dandy-Walker syndrome associated with congenital heart defects are reported, and their management is described. The various theories concerning the aetiology of the Dandy-Walker syndrome are discussed and it is suggested that the theory of primary developmental atresia of the foramina of Magendie and Luschka is still acceptable. If the child with Dandy-Walker syndrome requires treatment by extracranial CSF drainage it is proposed that a ventriculo-peritoneal shunt is preferable when there is any suspicion of cardiac anomaly. The proximal catheter should be placed in the posterior fossa cyst (dilated fourth ventricle) rather than in the lateral ventricle.


The tectum and the aqueduct of Sylvius in hydrocephalus unassociated with myelomeningocele. The brains of 30 children with hydrocephalus (but not myelomeningocele) were examined. It was found that secondary pressures on the tectum and aqueduct resulting from the hydrocephalus were responsible for further obstruction at this level in 15 of the 30 children and that they contributed to axial distortion in another 11 children. Occlusion of the aqueduct occurred as a result either of these external pressures or of internal gliosis. These events form a self-sustaining cycle which, if broken early, may lead to a more satisfactory control of the hydrocephalus.


Changes in regional blood-flow and water content of brain and spinal cord in acute and chronic experimental hydrocephalus. The effects of kaolin-induced hydrocephalus on regional blood-flow and water content of cat brain and spinal cord were measured. The role of the central canal of the spinal cord as an alternative pathway for cerebrospinal fluid in experimental hydrocephalus was also studied by positive contrast ventriculography. In comparison with normal cats, blood-flow in the cerebrum, cerebellum and brain stem of cats with acute hydrocephalus was reduced by more than 20 per cent: in those with chronic hydrocephalus it was reduced by only 12 per cent. There was an absolute increase of 1-5 per cent in water content of the brain in cats with acute hydrocephalus. Water content in the spinal cord was increased by 6 per cent in cats with acute hydrocephalus and by 8 per cent in those with chronic hydrocephalus. When the increased water-content was taken into account, hydrocephalus caused no significant change in blood-flow in the cervical, thoracic or lumbar spinal cord. Contrast material perfused through the ventricles of hydrocephalic cats flowed directly into the enlarged central canal of the spinal cord. Kaolin-induced arachnoiditis completely obstructed communication between the ventricles and the cranial subarachnoid space. The contrast material in the central canal communicated both with the cavities extending into the dorsal columns and with the spinal subarachnoid space. When kaolin was injected directly into the spinal subarachnoid space there was an increase in spinal water-content, without an enlarged central canal. These results suggest that in addition to kaolin-induced arachnoiditis, increased intraluminal pressure is necessary to enlarge the central canal.


The problems of design and implantation of shunt systems for the treatment of hydrocephalus. Engineers and surgeons concerned with the design and use of shunt systems for the treatment of hydrocephalus share the wish to avoid the implantation of defective devices and to improve existing shunt systems. This study considers the causes of shunt failure or malfunction and seeks to define the areas in which improvements are needed. An important factor in bringing about improvements is that surgeons communicate to designers and manufacturers their clinical observations of defective materials or performance in existing shunt systems.


A study of the Indian valve for ventriculo-atrial shunts in the treatment of hydrocephalus. Because of the high costs of importing commercially-available shunts, a hand-made ventriculo-atrial shunt was devised in India for the treatment of hydrocephalus. Modifications have been made to the original design and these shunts are now being produced commercially at a fraction of the cost of other available shunts. Hydrodynamic testing indicates that they compare favourably with the other shunts at present in use.


Antibiotic prophylaxis in shunt surgery. A system of antibiotic prophylaxis has recently been described which is said to lower the incidence of wound infection in various surgical procedures, and which also evades the problem of increase in resistant bacteria. In the investigation reported here, this system was applied to the prevention of colonisation following shunt surgery and was found to have no beneficial effect. It is suggested that this finding may be peculiar to operations involving the implantation of hollow devices.


The use of the valvogram for the detection of shunt blockage in hydrocephalic children. Valvography is a simple, safe, rapid, easily interpreted technique for the investigation of possible blockage of the distal end of the shunt system containing a Spitz-Holter valve. Details are presented of 64 investigations in 46 children, 30 of which demonstrated distal obstruction of the shunt system. The unreliability of some physical signs is discussed. No serious complications were encountered and the procedure has proved to be a valuable addition to the practical management of shunt-dependent children.


Increasing incidence of leukemia in infancy and childhood: a real challenge.


Immunological aspects of L-asparaginase treatment in children with lymphoproliferative disease. 14 children with acute lymphoblastic leukemia and 6 with lymphosarcoma were treated in 13 cures with 300-500 IU/kg bodyweight/day of L-asparaginase and in 11 cures with 501-760 IU/kg/day. An increase of all fractions of immunoglobulins with maximal values at the end of the cures was observed in the group treated with low doses. In the children receiving the high doses of this drug, an increase was observed only in the first 3 or 4 days of therapy and a decrease occurred at the end of the cure. Decreased IgM levels at the end of therapy were noted in children with acute leukemia. Anti-asparaginase antibodies occurred only in 3 children with anaphylactic shock.


Population cytology of the genus Phaulacridium. IV. Phaulacridium marginale (Walker)--the North Island populations. Samples of Phaulacridium marginale were taken from the North Island of New Zealand, together with further samples from three South Island populations. Seven of the North Island populations were found to be polymorphic for a small telocentric B chromosome. In only one case was the B chromosome significantly associated with an increase chiasma frequency. All three South Island populations contained B chromosomes. Seven of the nine N.I. populations were also polymorphic for extra segments on the centric end of the S11 chromosome. In six of them this polymorphism co-existed with that for B'S. A new polymorphism was encountered in two populations. This was for a large block of heterochromatic material located at the centric end of one of the smaller medium-sized chromosomes which thus becomes acro- rather than telocentric. Tt would appear that the New Zealand grasshopper, Ph. marginale, is able to tolerate many different polymorphisms for extra heterochromatin. However, this ability is perhaps restricted to central populations. In this context, the high level of occurence of these polymorphisms in the North Island could be due to the better climatological conditions existing there compared to most of the South Island.


Plutonium--health implications for man. Animal data on plutonium toxicity.


Selection equilibria in a multiallele single-locus setting. The aim of the paper is to clarify and unify various well-known results in the setting mentioned in the title, since some of these results are either inaccurate, or incomplete; or refer to different concepts bearing the same name. Emphasis is given to the general case, i.e. we include the situation of singular fitness matrix, a topic which is generally avoided. We proceed by using a specific generalized inverse of the fitness matrix. A full bibliography is given.


The effects of selection and human preference on coat colour gene frequencies in urban cats. In an attempt to examine the possibility of selection on domestic cats populations in the urban environment, a number of surveys were conducted in four contrasting areas of Glasgow--two near either extreme of Western, industrial socioeconomic status. The first survey was in the form of a questionnaire to inhabitants enquiring of preference for a particular phenotype. This survey revealed a consistent preference for lighter phenotypes in all areas. The incidence of cat ownership was greatest in the two affluent areas where there was also a high risk of the cat being sterilised. Independent of the questionnaire survey was a study of cat coat colour gene frequencies in each of the four districts. This study revealed that darker phenotypes predominate in the two areas of lower socioeconomic status, Maryhill and Govan. To date, the cat populations in these two areas are the darkest to have been described in the world. In contrast, a lighter phenotype was found in cats inhabiting the two districts of higher socioeconomic status, Kelvinside and Bellahouston. This difference in phenotypic darkness was also paralleled by appropriate clines in coat colour gene frequencies. The results demonstrate that human preference is not effectively translated into selection at any of the loci considered. In situations where human preference is most likely to occur, neutering risk is also high. Although the force responsible for the darkening of phenotype has yet to be identified, the fact that the darker alternative allele at each of the O, a, t, d, S and W loci is favoured suggests that selection is operating on these polymorphic coat colour loci.


Gene frequences in Icelandic cats.

Gene frequences in Icelandic cats. A survey of genetically determined coat polymorphisms of Icelandic cats, in Reykjavik and adjacent rural areas, has shown that these animals are quite distinct from cats previously studied in north-west Europe. The differences are interpreted to indicate that Icelandic cats represent a relict population reflecting the condition of north-west European cats in former times. Significant differences exist between the Reykjavik and rural samples studies. The Reykjavik population is more similar to north-west Europe, probably due largely to increased contact in recent years.


Population genetics of a "colonising" lizard: natural selection for allozyme morphs in Anolis grahami. Allozyme frequencies of Anolis grahami from Bermuda were compared to those from Jamaica. These lizards were introduced into Bermuda from Jamaica in 1905. The magnitude of the genetic changes were consistent with the hypothesis that these changes were produced by random genetic drift. The changes for the seperate alleles were, however, more heterogeneous than expected if caused by random drift alone. It is concluded that not all the alleles examined have been selectively neutral.


Chiasma frequency variation with altitude in Cepaea hortensis (můll.). Populations of Cepaea hortensis have been sampled from an area of 121 sq km on the north slopes of the Brendon Hills, Somerset, and analysed for chiasma frequency. Variation in chiasma frequency is due to variation in a single large bivalent--the A group bivalent. In 12 populations studied during 1973 no association between chiasma frequency and ecological factors could be detected. In particular, there is no evidence of a negative correlation of population density with chiasma frequency which is known to exist in populations of C. nemoralis within the area. In 1974, 17 populations, four of which were utilised in the 1973 analysis, were studied. Negative correlations of interstitial (but not total or terminal) chiasma frequency and between-cell variance with altitude were found. It is likely that the correlation of between-cell variance with altitude is due to the strong correlation of variance with chiasma frequency which exists in these populations. There is evidence from several populations that chiasma frequency is stable between years. The implications of the negative correlation of chiasma frequency with altitude and the lack of a correlation with population density are discussed.


Phenotypic selection in autopolyploids.

Phenotypic selection in autopolyploids. A simple demonstration, applicable to any ploidy level, that response to selection measured after one generation of random mating is proportional to the gametic variance, is given. The reduction in the coefficients of variance components during subsequent random mating generations is related to the approach of the population structure to various types of equilibria.


High coumarin 7-hydroxylase activity does not protect mice against Warfarin. Sixteen strains of mice varied widely in their ability to 7-hydroxylate injected coumarin to form umbelliferone, which is excreted in the urine. The same strains also varied in their resistance to the lethal effects of dietary Warfarin. There was no correlation between hydroxylating ability and Warfarin resistance.